手足口病患儿血清25-羟维生素D浓度与疾病严重程度及预后的关系

Relationships between the serum 25-hydroxyvitamin D concentration with the severity of disease and prognosis in children with hand-foot-and-mouth disease

目的分析手足口病(HFMD)患儿血清25-羟维生素D浓度与疾病严重程度及预后的关系。方法将本院2017年1月-2018年1月诊治的145例HFMD患儿分为普通组61例,重症组59例,危重型组25例,同时期体检健康的31例婴幼儿作为对照组。分别检测病例组和对照组血清25-羟维生素D、血乳酸(LAC)、肌酸激酶同工酶(CKMB)、白细胞(WBC)及空腹血糖水平,评估小儿危重症评分(PCIS),分析病例组血清25-羟维生素D水平与PCIS、LAC、CK-MB、WBC和血糖的相关性并分析HFMD病情危险因素。结果普通组和重症组患儿经治疗后全部治愈或好转,出院后3个月随访未见后遗症,危重型组患儿治愈或好转13例,其中5例患儿有神经系统后遗症,死亡12例。入院时,病例组血清25-羟维生素D水平和PCIS显著低于对照组,LAC、CK-MB、WBC和血糖水平显著高于对照组,差异均有统计学意义(P<0.05),危重型组血清25-羟维生素D水平和PCIS显著低于普通组和重症组,LAC、CK-MB、血糖和WBC显著高于普通组和重症组,差异均有统计学意义(P<0.05);危重症组生存患儿血清25-羟维生素D水平和PCIS显著高于死亡患儿,LAC、CK-MB、血糖和WBC显著低于死亡患儿,差异均有统计学意义(P<0.05);病例组血清25-羟维生素D水平与WBC及血糖水平呈中等负相关关系(r=-0.496、-0.453,P=0.000、0.000),与LAC、CK-MB呈弱负相关关系(r=-0.212、-0.294,P=0.034、0.021),与PCIS呈强正相关关系(r=0.582,P=0.000);25-羟维生素D、PCIS、血糖和WBC是HFMD病情严重程度的危险因素。结论血清25-羟维生素D水平与HFMD患儿病情严重程度有关,可作为诊断HFMD及预后的血清指标之一。

Objective To analyze the relationship between serum 25-hydroxyvitamin D concentration and disease severity and prognosis in children with hand-foot-and-mouth disease(HFMD).Methods 145 children with HFMD who were diagnosed in our hospital from January 2017 to January 2018 were divided into the general group of 61 patients,the severe group of 59 patients,the critically ill group of 25 patients,and 31 healthy infants with physical examination at the same time were selected as the control group.The serum of the case group and the control group were tested for serum 25-hydroxyvitamin D,blood lactate(LAC),creatine kinase-MB(CK-MB),white blood cell(WBC)and fasting blood glucose levels.Pediatric Critical Illness Score(PCIS)were assessed,and serum 25-hydroxyvitamin D levels were correlated with PCIS,LAC,CK-MB,WBC,and blood glucose,and risk factors for HFMD were analyzed.Results All the patients in the general group and severe group were cured or improved after treatment,no sequel were found at 3 months after discharge,in critical group,13 cases were cured or improved,12 cases died,and 5 cases had neurological sequel.At admission,the serum 25-hydroxyvitamin D level and PCIS in the case group were significantly lower than those in the control group(P<0.05);the levels of LAC,CK-MB,WBC and blood glucose were significantly higher than those in the control group(P<0.05);the serum 25-hydroxyvitamin D level and PCIS in the critical group were significantly lower than those in the normal group and the severe group(P<0.05);the levels of LAC,CK-MB,blood glucose and WBC were significantly higher than those in the normal group and the severe group(P<0.05);the serum 25-hydroxyvitamin D level and PCIS of surviving children were significantly higher than those of children with death in the critical group(P<0.05);LAC,CK-MB,blood glucose and WBC were significantly lower than those of dead children(P<0.05);the serum 25-hydroxyvitamin D level was negatively correlated with the levels of WBC and blood glucose in the case group(r=-0.496,-0.453,P=0.000,0.000),and was weakly negatively correlated with LAC and CK-MB(r=-0.212,-0.294,P=0.034,0.021),and was strong positively correlated with PCIS(r=0.582,P=0.000).25-hydroxyvitamin D,PCIS,blood glucose and WBC were risk factors for the severity of HFMD.Conclusion Serum 25-hydroxyvitamin D levels was related to the severity and prognosis in children with HFMD and could be used as one of the serum indicators for the diagnosis of HFMD.